TY - JOUR

T1 - Diagnosing, managing and preventing anaphylaxis

T2 - Systematic review

AU - de Silva, Debra

AU - Singh, Chris

AU - Muraro, Antonella

AU - Worm, Margitta

AU - Alviani, Cherry

AU - Cardona, Victoria

AU - DunnGlvin, Audrey

AU - Garvey, Lene Heise

AU - Riggioni, Carmen

AU - Angier, Elizabeth

AU - Arasi, Stefania

AU - Bellou, Abdelouahab

AU - Beyer, Kirsten

AU - Bijlhout, Diola

AU - Bilo, M. Beatrice

AU - Brockow, Knut

AU - Fernandez-Rivas, Montserrat

AU - Halken, Susanne

AU - Jensen, Britt

AU - Khaleva, Ekaterina

AU - Michaelis, Louise J.

AU - Oude Elberink, Hanneke

AU - Regent, Lynne

AU - Sanchez, Angel

AU - Vlieg-Boerstra, Berber

AU - Roberts, Graham

AU - European Acad Allergy

AU - Clinical Immunology Food Allergy

PY - 2021

Y1 - 2021

N2 - Background This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta-analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. Conclusions Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

AB - Background This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta-analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. Conclusions Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

KW - adrenaline

KW - anaphylaxis

KW - diagnosis

KW - epinephrine

KW - management

KW - prevention

KW - ACUTE ADVERSE-REACTIONS

KW - EPINEPHRINE AUTOINJECTOR

KW - FOOD-ALLERGY

KW - PEDIATRIC ANAPHYLAXIS

KW - AUTO-INJECTORS

KW - DOUBLE-BLIND

KW - MANAGEMENT

KW - RISK

KW - ADRENALINE

KW - CHILDREN

U2 - 10.1111/all.14580

DO - 10.1111/all.14580

M3 - Journal article

C2 - 32880997

VL - 76

SP - 1493

EP - 1506

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

SN - 0105-4538

IS - 5

ER -